Video Analysis for Ensuring Safer Diffusion of New Procedures New surgical procedures are introduced continuously into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into divers practice settings is often suboptimal. The uneven mastery of new techniques implied by these innovations may contribute to wide variations in outcomes and effectiveness across providers. Strategies for identifying best techniques and disseminating them would have clear benefits, but practical, scalable strategies have been elusive. Whether video analysis can be used for this purpose has not been explored. In this proposal, we will build on our recent work, published in NEJM, which uses vide analysis to assess surgical skill. Leveraging this prior work in the Michigan Bariatric Surgery Collaborative (MBSC), we will study sleeve gastrectomy, which was recently approved by the Center for Medicare and Medicaid Services (CMS). We have the following Specific Aims: Aim 1: To use surgical video analysis to examine variations in surgical technique. We will collect videos from all Michigan surgeons who perform sleeve gastrectomy. Using a standardized instrument, we will have peer reviewers assess each other's technique. The peer review instrument includes aspects of technique that relate to both short-term and long-term outcomes. Aim 2. To examine the relationship between surgical technique and patient outcomes. We will link these details on technique from video analysis to patient outcome data from the MBSC clinical registry. After adjusting for all potential confounders, we will assess the relationship between surgical technique and short-term safety outcomes and long-term effectiveness outcomes. Aim 3. To implement best technical practices and evaluate the impact on patient outcomes. . We will design and implement an intervention in a stepped wedge cluster randomized trial using the MBSC platform. The intervention will include a checklist of best practices, videos demonstrating the best practices, and coaching sessions by surgeons with expertise in these techniques. The most immediate impact of this work will be for patients undergoing sleeve gastrectomy in Michigan and beyond. However, the use of video analysis to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.